Penn study suggests balancing sedation in pediatric patients

For small children, being hospitalized can be an especially frightening experience. Above and beyond the challenges of whatever ailment they are being treated for, they are often connected to a variety of unpleasant tubes and monitors, which they may instinctively try to remove.

Standard practice in hospitals is to fully sedate highly instrumented children, but Penn Nursing’s Martha Curley says lighter, more finely-tuned sedation can be just as effective.

For small children, being hospitalized can be an especially frightening experience. Above and beyond the challenges of whatever ailment they are being treated for, they are often connected to a variety of unpleasant tubes and monitors, which they may instinctively try to remove.

Standard practice in hospitals is to fully sedate such children for their comfort and safety, but a new study, led by Martha Curley of Penn’s School of Nursing, shows that lighter, more finely-tuned sedation can be just as effective. Instead of being kept comatose, care providers can tune the level of sedation to the children’s level of illness, keeping them more awake and alert while still keeping them comfortable and safe.

Standard practice in hospitals is to fully sedate highly instrumented children, but Penn Nursing’s Martha Curley says lighter, more finely-tuned sedation can be just as effective.

The study, published in the Journal of the American Medical Association, shows that this individualized sedation protocol did not increase the time children spend on mechanical ventilators—necessary to help them breathe—and did not increase adverse events, such as pain and agitation.

Those factors being equal, having pediatric patients be more responsive is beneficial in monitoring their recovery and avoids some of the negative repercussions, such as bedsores, that can form after long periods of immobility. Simply using fewer sedatives is also a benefit, as the long-term effects of sedation on cognitive development remain unclear.

To better understand the right balance in the sedation equation, Curley led the study known as RESTORE. Data from adult patients showed that this minimal-sedation approach resulted in less time on ventilators. However, it was unclear whether such findings would apply to children, as they are less able to communicate their needs and have a harder time tolerating the various medical interventions performed on them.

“We wanted to know if we could keep kids in a more awake state and have it be safe for them.” Curley says. “If they’re uncomfortable, it’s a safety risk; what 2-year-old would ever lay quietly with strangers caring for them?”

Their findings, resulting from data gleaned from 2,449 pediatric patients, showed that their tailored protocol provided a minimum but effective level of sedation.

“We found that the sedation protocol didn’t reduce the time they were on the ventilators, but they had a different sedation experience,” Curley says. “The kids were more awake, more interactive, had fewer pressure ulcers. And being exposed to less of these toxic drugs is a potentially huge benefit for them. We can give kids the best ICU treatment and without harming them.”

Next steps in the RESTORE study will help clarify other health impacts that sedation has on pediatric patients. To better understand the long-term effects in the sedation equation, Curley is leading a longitudinal study known as RESTORE-Cognition with colleagues from Seattle Children’s Hospital.

“Part of our follow-up study will involve bringing these children back and, after controlling for multiple factors, figuring out which sedatives are the best from a cognitive impact perspective,” Curley says.